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Medical advances, improved access to care, prevention initiatives, and our nation's aspiration of an AIDS-free generation are all good signs, but as a culture we will need to shift our perspective to stop the spread of HIV.

Over the last 30 years, where have we failed? We know that HIV is still mostly spread by sexual behavior. Yet, the disease is rather easily preventable through the use of condoms. Condoms are reasonably inexpensive, potentially readily available, easy to use, and highly effective in preventing HIV and other sexually transmitted infections (and unintended pregnancy). What a bargain! So, why are they not used more?

Behavioral HIV prevention strategies and interventions have tried to get people to reduce risky sexual behavior and promote condom use. While reasonably effective, there needs to be continuous implementation of these interventions, and they are costly. Investment in prevention strategies has always been difficult.

New strategies are overdue. In the United States, we continue to experience 50,000 new infections a year, with young people aged 13-29 accounting for 39% of all new HIV infections.* And, there are serious health disparities. People of color, youth, and sexual minorities are much more likely to become infected than other groups. While 60% of new infections around the world are found in gay and bisexual men, only 2% of the global prevention budget is directed at this group. Also, transgender individuals are an overlooked population at major risk for HIV, due in large part to continued stigma and discrimination. This disparity in funding efforts represents the institutionalized stigmatization, heterosexism, and homophobia that exist in our cultures as well as in our public health systems. If we do not attend to this population as well as other marginalized populations such as sex workers and drug users, we will fail in our efforts to stop the spread of infections.

A fundamental problem remains. We remain a sexually dysfunctional culture. We live in a culture that is still uncomfortable talking about sex and sexuality in a mature and honest fashion. We continue to debate and hold back on providing comprehensive sexuality education. It is very clear that what distinguishes the United States from other developed countries in sexual health indicators is the existence of (or lack thereof) early and sustained comprehensive sexuality education. When kids are educated early they grow up to be more comfortable with talking about sexuality, more likely to be sexually responsible, and have lower rates of sexually transmitted infections and unintended pregnancies. They contribute to a cultural climate that is sexually healthy. That climate then insists on comprehensive sexuality education and thereby creates a cycle of healthiness. In the United States, we are still caught up in a negative and unhealthy vicious cycle. The goal of the Joycelyn Elders Chair in Sexual Health Education is to reverse this negative cycle.

As the current Chair in Sexual Health, I continue to push a sexual health agenda in HIV prevention. I believe in the need for a broad sexual health approach to stem the tide of the HIV epidemic. I envision an approach that goes beyond venereology and on an individual level

• emphasizes a positive and respectful approach to sexuality and sexual expression throughout the lifespan;

• acknowledges sexuality as a basic and fundamental aspect of our humanness and that the pursuit of sexual pleasure is natural and desirable;

• combats sexual coercion, shame, discrimination, and violence;

• promotes positive sexual identity and esteem;

• encourages honest communication and trust between partners;

• supports the possibility of having pleasurable, fulfilling, and satisfying sexual experiences;

• insists that individuals take responsibility of the consequences of their sexual choices and their impact on others; and

• respect for individual differences and diversity and a lack of societal prejudice, stigma, and discrimination.

As the Chair in Sexual Health, I will continue to work with our faculty at the Program in Human Sexuality and with partners around the world to promote a sexually healthier culture - not only to address the sexual problems in the world -- but to advance the opportunity for everyone to lead sexually healthier lives which are pleasurable and satisfying.

First of all, I have to say that I am grieving the loss of one our pioneering faculty members - Mary Briggs who you will read about in this newsletter. She was an amazing woman and I was fortunate enough to receive some training from here when I was an intern at PHS some 36 years ago!

I am writing this from Mexico where I have started a 6-month sabbatical. The purpose of this sabbatical is to study gender variance which is widespread throughout the world but cultures place different values upon gender identities and cross-gender behavior. In most parts of the world, gender variant identifies and behavioral expressions of those identities are highly stigmatized - although the struggle for acceptance is growing around the world. However, there are cultures where variations in gender identities are much more tolerated, embedded into the normative and historical societal structure of gender, and sometimes a revered phenomenon.

I have started my work here in Mexico in a small indigenous community in Juchitan, Oaxaca. Fifteen years ago, I began my work on this subject, and I have been back to Juchitan many times. From here I will be going to French Polynesia, Thailand, and Burma. These societies (or parts thereof) have a unique and less stigmatized view of gender variance and cross-gender behavior. I will also be visiting Micronesia (Marshall Islands) and Melanesia (Fiji) which have interesting phenomenon but not as positive a situation - but are useful as contrast. I have been studying these societies for many years in my spare time, and I am back to revisit and finalize my observations and conclusions. I am accompanied by Mariette Pathy Allen who will be accenting the data with a photographic study.

I am just concluding my field research with the muxes of Juchitan. Juchitan is a small indigenous community (Zapotec) in the state of Oaxaca, Mexico. I have been able to observe the changes and evolution of the culture and the individual lives of many of the muxes. In Juchitan, muxes are a broad spectrum of gender non-conforming males - which would span our western constructs of gay, cross-dresser, transgender, and transsexual. The vast majority of them have sex with other men - and they are mostly distinctively sexually attracted to 'straight men' or 'bisexual men' known as mayates. Some muxes are heterosexually married and have children - their status as muxe is well recognized by the wife and society. A muxe is identified as such from an early age - and because of the relatively small community is known by everyone as muxe. Most parents in Juchitan would simply understand this as a fate of nature as the Zapotec people are fairly agnostic.

While it is not something that is necessarily desired and many fathers have negative reactions to their son's cross-gender behavior, most muxes become recognized as an asset to the family. Muxes take on a social role of caretakers of the parents and family members (they do this from a very young age). They are traditionally bound to live with the family and living in long-term relationship with another person is not really acceptable (except it seems for the ones who marry a woman and raise their own family). There have been some recent stories of two muxes living together - which is a very new and rare phenomenon.

The muxes are a very interesting phenomenon - and one which you cannot find even in other parts of the state of Oaxaca - never mind Mexico. They have long held a unique status within society, recognized and respected because of their role within the family, and they often inherit family fortune. I would say that they gain acceptance through hard work and good deeds - but at least that option is afforded them. As such, many hold positions of respect and power. The muxes organized themselves as a "gay rights organization in the 1970s - becoming Mexico's earliest gay rights organization. They now wield considerable political power.

It is hard to generalize about muxes - as this is a phenomenon quite complex and dynamically changing. There has been a blending of modern constructs of "gay" and "trans." They defy fitting into either construct and may best be understood in the western constructs of "queer."

The situation in Juchitan is extremely unique and exists as a stark contrast to other indigenous communities or other rural areas in Mexico. Muxes defy simple definition as it is a unique gender role within society which is expressed in a variety of ways - which are, to varying degrees, accepted. Many hold on to the traditional cultural belief that there is a place for sexual and gender diversity in a community.

It is an illustration of a community where sexual and gender diversity can coexist and that diversity can be celebrated. It is not paradise as our binary way of thinking of gender and sexual orientation continues to cause pressure to conform or create prejudice for those that don't fit the binary. And the struggle to maintain the traditions and create even more acceptance continues. But, it is an interesting challenge to other societies to think about how everyone can contribute to society capitalizing on their uniqueness and differentness. And, all can be enriched by those who do not conform to gender expectations. I do believe that celebration of sexual and gender diversity is essential to everyone's sexual health.

Sara Mize, PhD, and Brian Zamboni, PhD, were interviewed for the article "Seven things physicians need to know about sex and the older adult." Also contributing to the article was June La Valleur, MD, retired University of Minnesota faculty member in the Department of Obstetrics, Gynecology and Women's Health and past-chair of the PHS Leadership Council.

Michael Miner, PhD, commented on sexual offender treatment, current research, and Minnesota's unique system in "View from the Hotel California: Is it possible to rehabilitate Minnesota's most serious sex offenders?"

Katie Spencer, PhD, discussed the Standards of Care and insurance coverage for transgender patients in "Falling Through the Cracks: Health insurance policies increasingly include coverage for treatments related to gender dysphoria, but gaps remain,"

Several PHS colleagues and collaborators were featured in the article, "Out: The climate has changed for gay and lesbian physicians," including Chip Martin, MD, chair of the PHS Leadership Council.

Minnesota Medicine is an award-winning publication of the Minnesota Medical Association.

While Feldman was working on her medical degree at University of Illinois, Urbana, she also completed a PhD in anthropology. In 1996, after a family medicine residency at Lutheran General Hospital in Park Ridge, IL, she joined the faculty at the Department of Family Medicine and Community Health at the University of Minnesota. Initially she worked as a family physician and trained residents in HIV/AIDS clinical care. In 1998, when the HIV/AIDS residency training program was eliminated, Feldman joined the faculty at the Program in Human Sexuality, replacing retiring physician Leon Nesvacil, MD. Feldman's interest in research, HIV, sexuality, and culture has made her a great fit for PHS. "Family physicians are uniquely qualified to address sexual health. They are trained in the whole person, across all ages and genders," said PHS director Eli Coleman, PhD,

Feldman's early research was in the area of HIV/AIDS.1 When she started at PHS she realized the lack of transgender-specific research and level-1 evidence. Since then, Feldman has been involved in studies focused on transgender health from HIV/AIDS prevention to the effects of hormone therapy. She has given numerous international presentations and published many scientific articles, book chapters, and guidelines based on her research in the areas of sexual functioning and transgender health. In addition to her recent publications2, Feldman is currently working on updating guidelines for The Fenway Institute for physicians on primary care of transgender patients and guidelines for physicians in British Columbia on the physical aspects of transgender endocrine therapy. Since 2001, Feldman has served as the chair for the World Professional Association for Transgender Health's Transgender Medicine and Research Committee. As she looks to the future, she is hopeful that the National Institutes of Health and other grant funding organizations will respond to the Institutes of Medicine report, The Health of Lesbian, Gay, Bisexual, and Transgender People(2011), by funding research in transgender health beyond the rubric of HIV.

Feldman is currently working with colleagues at PHS to build a framework for clinical research in the area of transgender health care. Feldman's current research includes looking at feminizing hormone therapy in patients over age 50; a retrospective, multicenter study on the long-term health of transgender individuals receiving hormone-therapy; and a study of immunological factors and the risk of Vulvodynia (based in U of M Epidemiology).

Feldman is involved in every aspect of education at PHS. She believes that, "Caring for a patient's whole health means that family physicians should be comfortable with sexuality." On most clinical days she is shadowed by medical students or residents from family medicine, obstetrics and gynecology, or other medical schools. She is the director of the sexual medicine course required for family medicine residents. Along with her colleagues, she is an instructor for the human sexuality course for first-year medical students and gives didactics for PHS postdoctoral fellows.

At the PHS clinic, the Center for Sexual Health, Feldman sees patients for all aspects of sexual medicine including sexual functioning concerns, women's sexual health, and transgender-specific care. In addition to her time at PHS, she see patients for two half days at the Women's Health Specialists Clinic at University of Minnesota Medical Center, Fairview.

A native of Chicago, Feldman lives in Saint Paul with her husband, sci-fi /fantasy writer Doug Hulick, and their two sons. Her hobby is historical rapier combat.

Ross, M.W., Rosser, B.R., McCurdy, S., Feldman, J.L. (2007) The advantages and limitations of seeking sex online: A comparison of reasons given for online and offline sexual liaisons by Men who have Sex with Men. Journal of Sex Research. 44(1):59-71

The University of Puebla and several other colleges in Puebla have collaborated to develop the Centro de Investigación en Sexología Dra. Beverly Whipple (CISex), dedicated on October 18, 2013, in Puebla, Mexico. Eli Coleman, PhD, will serve as a member of the center.

The dedication event was part of a research conference to launch the opening of the research center. Coleman made a presentation and workshop at the conference, "Parafilias en el Siglo XXI: Definiendo la Normalidad y Anormalidad en la Sexualidad Humana" and "Evaluación y tratamiento de Conducta sexual Impulsiva/compulsiva."

The mission of CISex is to advance collaborative sexuality research and promote the exchange of ideas across professions and academic disciplines. In her acceptance speech, Whipple said, "I hope that this research center will provide the incentive for many of you here in Puebla, and in other parts of Mexico, to conduct more research studies and to publish your findings. The field of sexual health has so much that we don't know about and there is the need for much new research. . . . We need to have your findings published, not only in Spain, Central and South America, but internationally."

Beverly Whipple, PhD, RN, FAAN, is Professor Emerita of Rutgers University in the College of Nursing. She is a certified sexuality educator, sexuality counselor, and sex researcher, and is the co author of the international best seller, The G Spot and Other Discoveries About Human Sexuality. Her other co-authored books are: Safe Encounters: How Women can say Yes to Pleasure and No to Unsafe Sex; Smart Women, Strong Bones; Outwitting Osteoporosis; The Science of Orgasm (2006); and The Orgasm Answer Guide (2010). Her concern with women's health derives naturally from her more than forty years of helping women to feel better about themselves, as a nurse, a nurse educator, and researcher.

The conference held October 12 - 13, 2013, featured keynote speakers Jamison Green, PhD, president-elect for the World Professional Association for Transgender Health; Victoria Kolakowski, the first openly transgender person to be elected as a trial court judge in the United States; and Andrea Jenkins, writer and multimedia visual and performance artist.

Alex Iantaffi, PhD, presented two workshops "Addressing internalized and systemic transphobia when working therapeutically with trans* and gender non-conforming youth and their families," and with Lauren Beach, JD, he presented, "Exploring the intersections between bisexual and transgender identities and organizing."

Katie Spencer, PhD, joined Carrie Link, MD, from Smiley's Family Medicine Clinic at an exhibit table to share with conference attendees transgender-specific care options through the University of Minnesota clinics.

Iantaffi presented, "Mindfulness in Motion: Using a body-based, narrative approach to sex therapy," which was based on the findings of a pilot study he conducted with at PHS with Sara Mize, PhD1. The study's scope was to explore the feasibility and acceptability of a sensorimotor therapeutic intervention for women's sexual health groups, with a significant mindfulness component. Initial findings indicated that, compared with pre intervention scores, overall mindfulness scores significantly improved following the intervention. In line with prior studies, the qualitative results indicated that participants found mindfulness skills to be particularly useful and transferable to their daily lives. Iantaffi provided attendees with examples of how to apply these approaches to individual and group therapy.

The conference was connected to a two-volume special issue of the journal Sexual and Relationships Therapy2 focusing on mindfulness and sexuality.

COSRT is an organization based in London that focuses on training, research, education, and regulation to enable sexual and relationship therapists to provide the most effective therapeutic treatments to the public.

If you were not able to join us for the great lecture by Debby Herbenick, PhD, MPH, you can now watch the video online or download the audio.

As part of the John Money Lecture series hosted by PHS, Herbenick presented "First Blush: Adolescent and Young Adult Sexual Experiences in America" at the University of Minnesota Medical School on September 13, 2013. Herbenick presented data from two nationally representative studies of sexual behavior in the United States - the 2009 and 2012 National Surveys of Sexual Health and Behavior, conducted by Herbenick and her colleagues at Indiana University. Together, the studies track the sexual experiences of about 10,000 Americans from ages 14 to 94.

Alex Iantaffi, PhD, and Cesar Gonzalez, PhD, will conduct a needs assessment with the transgender community focused on testing rates, medication adherence, and knowledge and acceptability of pre-exposure prophylaxis with transgender populations.

The one-year project was funded by the Developmental Center for AIDS Research (DCFAR) in the Academic Health Centre at the University of Minnesota. Iantaffi is the principal investigator and Gonzalez will serve as the co-investigator. Of the five DCFAR studies funded at the University, this is the only one that features a community based participatory research approach. The study will be completed in September 2014.

You can now download the play script for Trans/formation: Addressing Gender Issues in School, resources, and an educational supplement designed by Katie Spencer, PhD, and Dianne Berg, PhD.

Spencer said, "We hope that these materials will be a practical tool to help school administrators, teachers, student groups, and parents to begin an open and honest dialogue about gender. Schools could customize these materials to launch a semester-long awareness campaign or to conduct an afternoon assembly. Ideally the play will spark an ongoing conversation."

PHS joined Exposed Brick Theatre to create the play which is based on the stories, experiences, and perspectives of transgender and gender non-conforming youth. The aims of the project are to validate transgender and gender non-conforming youth experiences through performance, to educate peers, parents, families, friends, and educators about the experiences of transgender and gender non-conforming youth, and to encourage dialogues around gender issues, advocacy, and ally support for adolescents.

The educational supplement offers ideas for using the script in a classroom setting including ideas for casting and directing, preparation of the school and audience, rehearsal process and cast support, and questions for an audience discussion. Additional Spencer and Berg offer secondary resource links to gender terminology, a book list, and research on the experiences of transgender students.

The Tawani Foundation and the California Institute for Contemporary Art (CICA) have each made challenge grants to PHS to match new gifts and accelerated pledge payments to the Joycelyn Elders Chair in Sexual Health Education through December 31, 2013.

The Elders Chair fundraising is scheduled to be complete in 2016, however, these matching grants give us a great opportunity to secure the $2 million in gifts and pledges required to start the search for someone to be "seated" in the Elders Chair in 2014. The new faculty member hired to hold the Elders Chair will focus his or her efforts on creating comprehensive life-long sexual education curricula, increasing the number of health care providers and health educators trained in sexual health, and expanding scientific research in sexuality education. We are eager to put the Elders Chair to work sooner than later!

The challenge grants will match new gifts and accelerated pledge payments (scheduled for 2014 and beyond) 2:1 up to $50,000 now through December 31, 2013. That means that for every one dollar in new gifts and accelerated pledge payments two dollars will be given to the Elders Chair. After $50,000 in new and accelerated gifts have been received, the Tawani Foundation will continue to match 1:1 up to an additional $20,000.

Fundraising for the Elders Chair has been a grass roots effort with more than 290 donors including 23 organizations from 23 states in the US and 8 countries. Recently Joycelyn Elders, MD, shared what the Elders Chair means to her, and you can watch a video of her story.

Please help us meet these challenge grants. You may make a gift online at http://z.umn.edu/eldersgift, call 800-775-2187, or mail a check to University of Minnesota Foundation, McNamara Alumni Center, 200 Oak Street SE, Suite 500, Minneapolis, MN 55455 indicating "Elders Chair" in the memo line. If you would like information about making a gift of stock, contact Holly McDonough Gulden at 612.625-8758 or hmgulden@umn.edu.

Mary loved life and her heart was generous in sharing her love with nearly everyone she came to know. She was a woman of immense spirit, with a capacity for savoring and appreciating every moment of her varied and wide-ranging experience.

Around 1970, she joined PHS. Then, as 19-year-old assistant to Rick Chilgren, who was newly appointed director of this fledgling program, she virtually held things together through the first faltering steps of "the birth of PHS." Mary helped recruit many of our 'pioneers' through her enthusiasm and, with Rick, she united us to pull together in that great effort. She won over a number of folks who would later become pillars of our PHS community.

Her presentations on human sexuality at seminars and Sexual Attitude Reassessments were so personally honest and delivered with such natural good humor that many who came expecting to be offended, were instead "converted" to believing in the possibility of "healthy sexual attitudes."

When, around the late 1970's, PHS underwent a major reorganization as it moved from an interdisciplinary program within the Medical School Dean's Office to the Department of Family Medicine, several of the original founders departed. Around 1980 Mary moved to California where she embarked upon a new life of adventures.

There, she held numerous interesting jobs over the years, always with the same competence and self-assurance and dedication as she had at PHS. She met her partner, David, and travelled with him to his home in England. Then, together, they came back and opened a bookstore in Mill Valley and lived on a houseboat in Sausalito. Their son, Will, was born some years later and Mary enjoyed an interlude of devoted motherhood.

In 2010, when her beloved sister, Nancy, became terminally ill with cancer, Mary made many visits to Minnesota, and stayed at Nan's side for her final weeks in hospice. During those weeks Mary kept a journal for Nan on Caring Bridge, sharing all the heartfelt grief and joy of her sister's passing. Nancy died on November 1, 2010. Only a year later Mary, herself, was undergoing intensive treatments for breast cancer.

Meanwhile, Will married Shannon, making Mary very proud and happy. Then, as Mary recovered from the treatments, her son and daughter-in-law gave birth to little Hannah the grand-daughter who gave Mary her very greatest pleasure.

But shortly thereafter Mary was diagnosed with terminal metastatic bone cancer, which she stoically determined to let run its course (curse?) with only at-home hospice care. Since July 2013, many have been following Mary's inspired journal entries on her own Caring Bridge website where she gave us all a profound lesson on how to die with grace and good humor.

Mary passed away on November 4, 2013, in her home with David at her side. She had just celebrated her 65th birthday in October.